scholarly journals P-EGS02 Impact of delayed elective laparoscopic cholecystectomy on incidence and complications from gallstone ileus

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Mazuin Talib ◽  
Zhi Yu Loh ◽  
Hidayatul Abdul Malek ◽  
Vivekananda Sharma ◽  
Venkat Kanakala
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Ct Scan ◽  
Negative Impact ◽  
Gallstone Ileus ◽  
Gallstone Disease ◽  
Emergency Laparotomy ◽  
Number Of Patients ◽  
Elective Laparoscopic Cholecystectomy ◽  
Operative Notes ◽  
The Impact

Abstract Background The negative impact of the COVID-19 pandemic on the provision of elective surgery in the UK has been profound. Per the latest National figures, a total of 4.59 million patients are awaiting an elective operation (1). In our Trust, emergency operations and cancer service took precedence as we worked to minimize risks of COVID-19 while providing life-saving procedures. Subsequently, our ‘hot gallbladder’ operating list was put on hold for a period of 18 months. In our Trust, the current waiting time for an elective laparoscopic cholecystectomy is 52 weeks for symptomatic gallstone disease. Gallstone ileus is a well-recognized but rare complication of gallstones (2) and needs operative treatment. We performed this study to investigate the impact of delayed cholecystectomy on the incidence of gallstone ileus and the morbidity and mortality associated with this. Methods Retrospective study reviewing all acute admissions with gallstone ileus for 4 years from 2016 to 2020. Total number of patients was 19. Data collated from patient’s notes to include demographics and co-morbidities, operative notes, theatre records, and WebICE. Results Demographically, there was significant female preponderance (M : F : 1 : 18). Mean age of patients was 76.7 years. 17/19 patients underwent laparotomy as the primary operation (89%) and 1 (5%) had a laparoscopic procedure. 1 patient (5%) was managed conservatively. All patients had a CT scan as pre-operative imaging. 7 (34%) also had USS and 4 (20%) had MRCP. Mean length of stay in hospital was 13 days. 3 (15%) patients required re-admission to hospital for surgical and medical complications within 30 days. 3 (15%) patients returned to theatre for a second laparotomy within the index admission for recurrence of gallstone ileus. 8 (40%) patients had post-operative complications. There were 2 (10%) mortalities. 9 (45%) patients had gallstone related complications preceding their index presentation; majority (66%) which was calculous cholecystitis. The mean time between diagnosis of gallstone disease and emergency laparotomy for gallstone ileus was 38 months. Conclusions Gallstone ileus can be a life-threatening complication of gallstone disease and needs prompt recognition and treatment. Patients with known gallstones with symptoms of bowel obstruction should have a CT scan at time of presentation. Surgery is the mainstay treatment following resuscitation and concurrent conservative management. Early elective laparoscopic cholecystectomy can prevent mortality and morbidity from emergency laparotomy for gallstone ileus.

scholarly journals Impact of COVID-19 pandemic on the oncologic care continuum: urgent need to restore patients care to pre-COVID-19 era

2021 ◽  
pp. 1-11
Author(s):  
Ernest Osei ◽  
Ruth Francis ◽  
Ayan Mohamed ◽  
Lyba Sheraz ◽  
Fariba Soltani-Mayvan
Keyword(s):  
Cancer Care ◽  
Healthcare Professionals ◽  
Negative Impact ◽  
System Level ◽  
Care Continuum ◽  
Cancer Services ◽  
Number Of Patients ◽  
Prevention Programmes ◽  
Screening And Prevention ◽  
The Impact

Abstract Background: Globally, cancer is the second leading cause of death, and it is estimated that over 18·1 million new cases are diagnosed annually. The COVID-19 pandemic has significantly impacted almost every aspect of the provision and management of cancer care worldwide. The time-critical nature of COVID-19 diagnosis and the large number of patients requiring hospitalisation necessitated the rerouting of already limited resources available for cancer services and programmes to the care of COVID-19 patients. Furthermore, the stringent social distancing, restricted in-hospital visits and lockdown measures instituted by various governments resulted in the disruption of the oncologic continuum including screening, diagnostic and prevention programmes, treatments and follow-up services as well as research and clinical trial programmes. Materials and Methods: We searched several databases from October 2020 to January 2021 for relevant studies published in English between 2020 and 2021 and reporting on the impact of COVID-19 on the cancer care continuum. This narrative review paper describes the impact of the COVID-19 pandemic on the cancer patient care continuum from screening and prevention to treatments and ongoing management of patients. Conclusions: The COVID-19 pandemic has profoundly impacted cancer care and the management of cancer services and patients. Nevertheless, the oncology healthcare communities worldwide have done phenomenal work with joint and collaborative efforts, utilising best available evidence-based guidelines to continue to give safe and effective treatments for cancer patients while maintaining the safety of patients, healthcare professionals and the general population. Nevertheless, several healthcare centres are now faced with significant challenges with the management of the backlog of screening, diagnosis and treatment cases. It is imperative that governments, leaders of healthcare centres and healthcare professionals take all necessary actions and policies focused on minimising further system-level delays to cancer screening, diagnosis, treatment initiation and clearing of all backlogs cases from the COVID-19 pandemic in order to mitigate the negative impact on cancer outcomes.

scholarly journals P17 An audit of Trakcare discharge times for Laparoscopic Cholecystectomy

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Jacob Rapier ◽  
Steven Hornby ◽  
Jacob Rapier
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Initial Data ◽  
Best Practice ◽  
Average Length ◽  
Accurate Data ◽  
Day Case ◽  
Average Length Of Stay ◽  
Number Of Patients ◽  
Elective Laparoscopic Cholecystectomy

Abstract Introduction Nationally 61,220 Laparoscopic Cholecystectomies are carried out annually. Those carried out as day-cases reduce providers’ costs and increase income through the best practice tariff. The system in our trust to record discharges is ‘Trakcare’. The aim of this audit was to accurately measure the discharge times of patients undergoing elective Laparoscopic Cholecystectomies, to try and reduce the number of patients recorded as having an overnight stay by accurate data collection. Methods Initial data was collected for all elective Laparoscopic Cholecystectomy discharge times on Trakcare, over a 1 month period. This data was then re-audited prospectively both from Trakcare and discharges reported by nurses/patients. A comparison was then made of Trakcare against reported discharge times. Results Initially 54 operations were recorded, with 30 completed as day cases (55.6%). The re-audited data (on Trakcare) recorded 47 operations, with 15 completed as day cases (37.91%). Of these discharges we were able to capture 26 (55.32%) manually, and 11 were completed as day cases (42.31%). Measuring these 26 with the same operations on Trakcare we were unable to show a difference in the number of cases completed as a day case (11 vs 11), with only a 33 minute decrease in the average length of stay. Conclusion Trakcare is a reliable tool for measuring the date of discharge for patients. The recommendations in are: scheduling surgery for a time pre-13:00 shows a higher proportion of patients discharged the same day, and continue to use Trakcare to record discharge times.

scholarly journals AMBULATORY LAPAROSCOPIC CHOLECYSTECTOMY IS SAFE AND COST-EFFECTIVE: a Brazilian single center experience

2016 ◽  
Vol 53 (2) ◽  
pp. 103-107 ◽  
Author(s):  
Uirá Fernandes TEIXEIRA ◽  
Marcos Bertozzi GOLDONI ◽  
Mayara Christ MACHRY ◽  
Pedro Ney CECCON ◽  
Paulo Roberto Ott FONTES ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Selection Criteria ◽  
Outpatient Surgery ◽  
Gallstone Disease ◽  
Cost Savings ◽  
Cost Effective ◽  
Single Center ◽  
Single Center Experience ◽  
Elective Laparoscopic Cholecystectomy ◽  
Liver Biopsies

ABSTRACT Background - Laparoscopic cholecystectomy is the treatment of choice for gallstone disease, and has been perfomed as an outpatient surgery in many Institutions over the last few years. Objective - This is a retrospective study of a single center in Brazil, that aims to analyze the outcomes of 200 cases of ambulatory laparoscopic cholecystectomy performed by the same Hepato-Pancreato-Biliary team, evaluating the safety and cost-effectiveness of the method. Methods - Two hundred consecutive patients who underwent elective laparoscopic cholecystectomy were retrospectively analyzed; some of them underwent additional procedures, as liver biopsies and abdominal hernias repair. Results - From a total of 200 cases, the outpatient surgery protocol could not be carried out in 22 (11%). Twenty one (95.5%) patients remained hospitalized for 1 day and 1 (4.5%) patient remained hospitalized for 2 days. From the 178 patients who underwent ambulatory laparoscopic cholecystectomy, 3 (1.7 %) patients returned to the emergency room before the review appointment. Hospital cost was on average 35% lower for the ambulatory group. Conclusion - With appropriate selection criteria, ambulatory laparoscopic cholecystectomy is feasible, safe and effective; readmission rate is low, as well as complications related to the method. Cost savings and patient satisfaction support its adoption. Other studies are necessary to recommend this procedure as standard practice in Brazil.

scholarly journals The Impact of Debt Burden on the Number of Suicides in the Russian Regions

2021 ◽  
Vol 17 (4) ◽  
pp. 97-117
Author(s):  
Svetlana Doroshenko ◽  
◽  
Olga Sanaeva ◽  
◽  
Keyword(s):  
Mental Disorders ◽  
Unemployment Rate ◽  
Rural Areas ◽  
Negative Impact ◽  
Generalized Method Of Moments ◽  
Russian Regions ◽  
Debt Burden ◽  
Suicide Rates ◽  
Number Of Patients ◽  
The Impact

Population size is one of the most important parameters of national social and economic systems. This parameter is controlled by a variety of factors (components) that form ambiguous and complex feedback circuits. The most important issue is the study of the behavioral reactions of the population, which form certain parameters of the dynamics of the population. The authors consider only one behavioral reaction that seems to them to be important – the propensity for suicide, which ultimately leads to the formation of the suicide dynamics and which entails serious socio-economic and demographic losses. We put an emphasis on assessing the impact of financial parameters, namely households’ debt burden, on the suicide rates in the Russian regions. An econometric assessment of the influence of individual debt on the number of suicides among other socio-economic factors (unemployment rate, logarithm of GRP per capita, divorce rate, number of patients with mental disorders, average actual working week, number of alcoholics) was carried out for the regions among rural, urban populations and total. We use panel data for 80 Russian regions covering the period from 2005 to 2018. We apply the generalized method of moments (GMM) using Stata 14 statistical package. The empirical analysis demonstrates negative impact of the amount of individual debt on the number of suicides in the regions of Russia, which contradicts the results of similar studies conducted for developed economies. At the same time, some results obtained earlier in domestic and foreign studies have been confirmed, including an existence of a parabolic (U-shaped) dependence between the length of working hours and the suicide rates in the regions of the Russian Federation. In addition, there is a direct connection between an increase in the committed suicides and an increase in divorce rates and the number of patients with mental disorders. Moreover, we find out that the rise in unemployment rate and alcohol consumption leads to an increase in the number of committed suicides. This effect is especially perceptible among the people living in rural areas

scholarly journals Laparoscopic cholecystectomy: a prospective cohort study assessing the impact of grade of operating surgeon on operative time and 30-day morbidity

2018 ◽  
Vol 100 (3) ◽  
pp. 178-184 ◽  
Author(s):  
H Tafazal ◽  
P Spreadborough ◽  
D Zakai ◽  
N Shastri-Hurst ◽  
S Ayaani ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Cohort Study ◽  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Operative Time ◽  
Gallstone Disease ◽  
Surgical Trainees ◽  
The Impact

Introduction There is an increasing trend towards day case surgery for uncomplicated gallstone disease. The challenges of maximising training opportunities are well recognised by surgical trainees and the need to demonstrate timely progression of competencies is essential. Laparoscopic cholecystectomy provides the potential for excellent trainee learning opportunities. Our study builds upon previous work by assessing whether measures of outcome are still affected when cases are stratified based on procedural difficulty. Material and methods A prospective cohort study of all laparoscopic cholecystectomies conducted at a district general hospital between 2009 and 2014, performed under the care of a single consultant. The operative difficulty was determined using the Cuschieri classification. The primary endpoint was duration of operation. Secondary endpoints included length of hospital stay, delayed discharge rate and 30-day morbidity. Results A total of 266 laparoscopic cholecystectomies were performed during the study period. Mean operative time for all consultant-led cases was 52.5 minutes compared with 51.4 minutes for trainees (P = 0.67 unpaired t-test). When cases were stratified for difficulty, consultant-led cases were on average 5 minutes faster. Median duration of hospital stay was equivalent in both groups and there was no statistical difference in re-attendance (12.9% vs. 15.3% P = 0.59) or re-admission rates (3.2% vs. 8.1% P = 0.10) at 30 days. Conclusions Our study provides evidence that laparoscopic cholecystectomy provides a good training opportunity for surgical trainees without being detrimental to patient outcome. We recommend that, in selected patients, under consultant supervision, laparoscopic cholecystectomy can be performed primarily by the surgical trainee without impacting on patient outcome or theatre scheduling.

scholarly journals Cholelithiasis and laparoscopic cholecystectomy: identifying the appropriate time for operative intervention

2021 ◽  
Author(s):  
Ravi Kotecha ◽  
Vishwa Kotecha
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gold Standard ◽  
Complete Resolution ◽  
Prospective Observational Study ◽  
Surgical Intervention ◽  
Gallstone Disease ◽  
Duration Of Symptoms ◽  
Number Of Patients ◽  
Before And After ◽  
Group B

Background: Cholelithiasis is the most common among hepatobiliary disease and often requires surgical intervention. Laparoscopic cholecystectomy is the gold standard nowadays. This research paper was done to know appropriate time for laparoscopic cholecystectomy and how much improvement will we get after laparoscopic cholecystectomy.Methods: In our prospective observational study, 118 patients of cholelithiasis, 59 with dyspepsia in one group and 59 without dyspepsia in another group were taken. Both groups patients were analysed with Bucklay validated dyspeptic score before and after laparoscopic cholecystectomy till 6 months postoperatively for score improvement.Results: In our study, we confirmed that there was improvement in Buckley validated dyspeptic score in both group of patients with dyspepsia and without dyspepsia 6 month after laparoscopic cholecystectomy but not complete improvement. Improvement in Buckley validated dyspeptic score 6 months after laparoscopic cholecystectomy was more in patients with less duration of symptoms and less frequency of episode preoperatively and in non-dyspeptic patients.Conclusions: We could conclude that even earlier surgery after onset of symptoms didn’t result in complete resolution of symptoms in both groups particularly in group B (patients with dyspepsia). We can say that weather it is dyspeptic or non-dyspeptic gallstone disease, it has benefit from laparoscopic cholecystectomy but we can also say that improvement achieved is not complete as after laparoscopic cholecystectomy there were still number of patients who had Buckley validated score more than 6 in both groups after 6 months of surgery.

scholarly journals P-EGS14 From Gallstone Disease to Cholecystectomy: An audit looking at the waiting times for cholecystectomy in a small District General Hospital

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Jacob Mewse ◽  
Virginia Ledda ◽  
Ellie Connor ◽  
Peter Frank Mason
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Waiting Time ◽  
Negative Impact ◽  
Elective Surgery ◽  
Waiting Times ◽  
Gallstone Disease ◽  
Gastrointestinal Surgery ◽  
Emergency Operation ◽  
Biliary Colic ◽  
Emergency General Surgery

Abstract Background Gallstone-related disease accounts for a third of emergency general surgery admissions and referrals. The average waiting time for acute gallstone presentations to laparoscopic cholecystectomy is about 7 days in England. This audit aims to identify emergency admissions and compare local management to the Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS) guidelines standards with a focus on waiting times for laparoscopic cholecystectomy (LC). Where AUGIS standards were not met, number of re-admissions and complications were identified. A cost analysis was also completed looking at the overall costs of delayed treatment. Methods We identified all patients admitted as an emergency between September 2019 and September 2020 with gallstone-related pathology. Patients not referred to the surgical team, with negative Ultrasound Scans (USS) or known HPB malignancy were excluded. The patients were divided into a pre- COVID -19 and during COVID-19 category (respectively before and after March 2020), to identify whether the cancellation to non- urgent elective surgery (due to COVID-19) had caused further delays or complications. Each patient’s management was compared to AUGIS guidelines depending on their diagnosis at presentation (biliary colic, cholecystitis, cholangitis, gallstone-related pancreatitis), focusing on the timing between presentation and LC. Results A total of 99 patients were identified. Of the patients presenting with biliary colic (n = 9 pre-COVID, n = 5 during COVID), none underwent LC within 72 hours from presentation as recommended by AUGIS. Of the patients presenting with cholecystitis (n = 20 pre-COVID and n = 16 during COVID), none had LC within the recommended 72 hours. 5 patients in each COVID group had LC, with a significantly longer waiting time compared to the pre-COVID group. Re-admissions and complications were similar for the cholecystitis patients in both COVID groups. In the gallstone-related pancreatitis group, only 1 patient underwent LC within the recommended 2 weeks. Conclusions This audit showed that locally we are failing to meet AUGIS guidelines for LC within 72 hrs, 2 weeks or 6 weeks both pre and during COVID. This has caused re-admissions of patients with cholecystitis, pancreatitis and perforated gallbladders. Factors that cause delay are limited access to USS, limited staff and theatre availability. To improve outcomes, it is necessary to implement a hot gallbladder service with dedicated theatre slots. A change in the overall perception of LC is also needed: this is should be considered an emergency operation as its delay has a significant negative impact on patients’ outcomes.

Extrapulmonary tuberculosis during the COVID-19 pandemic: features of detection and course

2021 ◽  
pp. 585-589
Author(s):  
Ekaterina V. Kulchavenia ◽  
◽  
Ekaterina V. Kulchavenia ◽  
Keyword(s):  
Negative Impact ◽  
Extrapulmonary Tuberculosis ◽  
Abdominal Tuberculosis ◽  
First Year ◽  
Large Variability ◽  
Number Of Patients ◽  
Federal Districts ◽  
Novel Coronavirus ◽  
Far Eastern ◽  
The Impact

Background. COVID-19 pandemic caused by novel coronavirus has destabilized the world's health systems, revealing flaws in the organization of work in extreme conditions. Currently, there is limited empirical data on the impact of COVID-19 on tuberculosis outcomes. Materials and methods. Non-interventional comparative retrospective cohort study of the structure of the incidence of extrapulmonary tuberculosis (EPTB) in the Siberian and Far Eastern Federal Districts for the period 1999–2020 was carried out. Data of 13 852 patients were analyzed. Results. Of all 13 852 EPTB patients who were first diagnosed during the study period, the majority of cases (973) were registered in 1999, and the smallest number (550) – in 2017. Then, for 2 years, an increase in EPTB incidence was observed again (582 cases in 2018, and 563 cases in 2019) with a natural reduction by 18.5% in 2020 (459 cases). Over the first year of the COVID-19 epidemic, the incidence of central nervous system tuberculosis decreased by almost half (by 45.9%), the incidence of peripheral lymph nodes tuberculosis remained virtually unchanged, and the number of cases of "other" localizations, mainly abdominal tuberculosis, increased by 55.3%. Overall, in the Siberian and Far Eastern Federal Districts, the detection of isolated forms of EPTB over the first year of the pandemic reduced by 18.5% (from 563 to 459 patients). A large variability of data was found across regions. Thus, in the Novosibirsk, Tomsk and Omsk regions there was a significant decrease in the number of patients diagnosed with isolated EPTB (by 30.2; 47.1 and 64.5%, respectively) while in the Kemerovo and Irkutsk regions, the number of patients with isolated EPTB increased (by 80.9 and 32.3%, respectively). Conclusion. COVID-19 has had a significant negative impact on all services of national and global healthcare, the ultimate losses we have yet to calculate. Diagnostics of any diseases, and particularly EPTB, in the first year of the pandemic was difficult due to the restriction of patient visits to medical and preventive institutions, the closure or re-profiling of some of them, as well as a decrease in the number of specialists due to their selfisolation, re-profiling and COVID-19 disease. Nevertheless, the role of EPTB is still important.

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